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PA Bulletin, Doc. No. 09-2130


Children's Health Insurance Program; Benefit Changes and State Plan Amendment; Notice 2009-09

[39 Pa.B. 6609]
[Saturday, November 14, 2009]

 The Insurance Department has or will implement several benefit changes and other changes on December 1, 2009, the beginning of its next plan year. The Children's Health Insurance Program Reauthorization Act of 2009 (CHIPRA or Public Law 111-3), which reauthorized the Children's Health Insurance Program (CHIP), requires several of these changes, and allows for other changes. Consistent with Federal law, the mandated benefit and administrative changes are included in a State Plan Amendment being submitted to the Centers for Medicare and Medicaid Services (CMS) on or before December 1, 2009. The State Plan Amendment also includes other changes planned by Pennsylvania's CHIP, some of which are permitted by CHIPRA and some of which are not addressed in CHIPRA.

 CHIPRA mandated changes already in effect:

 • Increase the premium payment grace period from 10 days to 30 days

 • Provide notice during the 30 day grace period that coverage will terminate at the end of the grace period if payment is not received

 CHIPRA mandated changes to be effective December 1, 2009:

 • Verify citizenship of applicants—requires the Social Security Number of applicant children to be included on the application

 • Automatic enrollment of a newborn child in Medicaid or CHIP for 1 year if the child is born to a targeted low-income woman who was receiving pregnancy-related assistance through CHIP on the date of the child's birth

 • Provide mental health parity—places limit on physical health outpatient visits to match the outpatient limits for mental health at 50 visits per year. This requirement will exclude well-baby and well-child visits

 • Implement the Prospective Payment System or an alternative payment methodology to reimburse Federally Qualified Health Centers

 Other amendments to be effective December 1, 2009, or as soon as possible:

 • Modify certain benefits by eliminating the lifetime maximums and adding hospice care to the benefit package

 • Simplify the applicant and enrollee protection process

 • Add verification of immigrant status through the Systematic Alien Verification for Entitlements program

 • Specifically include Autism Spectrum Disorders (ASD) as a covered benefit under CHIP to pay for claims up to the point of the diagnosis of the ASD and referral to the Department of Public Welfare for an eligibility determination.

 The State Plan Amendment also identifies the following CHIPRA options that Pennsylvania plans to pursue upon CMS approval:

 • Implement a match with the Social Security Administration for verification of citizenship status. This reduces the burden on applicants to provide original documentation

 • Elect to provide coverage to children who are lawfully residing in the United States and are otherwise eligible for CHIP including optional targeted low-income children described in section 1905(u)(2)(B) without a 5-year delay

 The complete proposed CHIP State Plan Amendment will be available through the Insurance Department's web site at

Insurance Commissioner

[Pa.B. Doc. No. 09-2130. Filed for public inspection November 13, 2009, 9:00 a.m.]

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